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Indian Pediatrics Jun 2024Pre discharge pulse oximetry screening (POS) is recommended to pick up critical congenital heart diseases in apparently well neonates. However, it is possible that cases...
Pre discharge pulse oximetry screening (POS) is recommended to pick up critical congenital heart diseases in apparently well neonates. However, it is possible that cases may be missed during the early POS in the presence of delayed closure of the ductus arteriosus. Repeat POS in the second week of life was found to be helpful and feasible for early detection of pathological states causing hypoxemia in seemingly well neonates. Studies with larger sample size are recommended to establish the role of an additional POS in the second week for enhanced CCHD detection.
PubMed: 38859649
DOI: No ID Found -
Zhonghua Jie He He Hu Xi Za Zhi =... Jun 2024To evaluate the application value of portable pulse oximeter in adult obstructive sleep apnea (OSA). This study prospectively enrolled adult patients who underwent...
To evaluate the application value of portable pulse oximeter in adult obstructive sleep apnea (OSA). This study prospectively enrolled adult patients who underwent polysomnography (PSG) due to snoring at the Respiratory and Sleep Medicine Department of Peking University People's Hospital from July 2022 to July 2023. During PSG monitoring, CS-WOxi was continuously used to monitor blood oxygen levels. The consistency between 3% oxygen desaturation index (ODI) measured by portable pulse oximeter and ODI of polysomnography was evaluated using difference test, Pearson's correlation coefficient, and Bland-altman method. Receiver operating characteristic curve was used to determine the optimal threshold for diagnosing OSA. A total of 184 subjects were included, including 121 males (65.8%) and 63 females (34.2%). The mean age was 46.0 (34.3, 59.0) years, body mass index was 26.0 (23.3, 29.6) kg/m², and the apnea-hypopnea index was 18.2 (5.8, 40.8) events/h. There was a significant difference between CS-ODI and PSG-ODI [17.1(6.2, 42.7) 14.0(2.9, 32.6), <0.001], and the Pearson correlation coefficient was 0.93 (<0.001). There was a good correlation between CS-ODI and PSG-AHI (=0.92, <0.001). Bland-Altman consistency test showed that the average difference between the two was 0.7 events/h, and the 95% consistency limit was (-17.9, 19.3 events/h). When the CS-ODI≥5 events/h was used to identify OSA, the sensitivity was 94.4%, the specificity was 80.0%, and the accuracy was 91.3%. When PSG-AHI≥5 events/h was used as the diagnostic criteria, the area under the receiver operating characteristic curve was 0.933. Portable pulse oximeter can monitor pulse oxygen saturation accurately and has good sensitivity and specificity for OSA high-risk patients, and is a reliable tool for OSA screening.
Topics: Humans; Sleep Apnea, Obstructive; Oximetry; Female; Male; Middle Aged; Adult; Polysomnography; Prospective Studies; ROC Curve; Sensitivity and Specificity; Body Mass Index; Oxygen
PubMed: 38858202
DOI: 10.3760/cma.j.cn112147-20231113-00306 -
Lung Jun 2024Skin pigmentation influences peripheral oxygen saturation (SpO) compared to arterial saturation of oxygen (SaO). Occult hypoxemia (SaO ≤ 88% with SpO ≥ 92%)...
Characterizing the Racial Discrepancy in Hypoxemia Detection in Venovenous Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis.
PURPOSE
Skin pigmentation influences peripheral oxygen saturation (SpO) compared to arterial saturation of oxygen (SaO). Occult hypoxemia (SaO ≤ 88% with SpO ≥ 92%) is associated with increased in-hospital mortality in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO-SaO discrepancy due to significant hemolysis.
METHODS
Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO and SaO measurements from over 500 centers in the Extracorporeal Life Support Organization Registry (1/2018-5/2023) were included. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO-SaO calculations.
RESULTS
Of 13,171 VV-ECMO patients, there were 7772 (59%) White, 2114 (16%) Hispanic, 1777 (14%) Black, and 1508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic patients versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively). In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18-2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95% CI = 1.16-2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95% CI = 1.15-2.55, P = 0.008) had higher risk versus White patients. Higher pump flow rates (aOR = 1.29, 95% CI = 1.08-1.55, P = 0.005) and on-ECMO 24-h lactate (aOR = 1.06, 95% CI = 1.03-1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia.
CONCLUSION
SaO should be carefully monitored if using SpO during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
PubMed: 38856932
DOI: 10.1007/s00408-024-00711-4 -
Journal of Clinical Medicine Research May 2024Epidemiological studies have demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients often develop atrial fibrillation,...
BACKGROUND
Epidemiological studies have demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients often develop atrial fibrillation, premature ventricular contractions (PVCs), and conduction disorders. The manifestation of ventricular cardiac arrhythmias accentuates the risk of sudden cardiac death.
METHODS
A retrospective study was conducted on the cohort of 1,614 patients admitted for coronavirus disease 2019 (COVID-19). Patients were categorized into two groups based on the occurrence of PVCs. Group I comprised 172 patients diagnosed with PVCs of Lown-Wolf class II - IV upon hospital admission; group II (control group) consisted of 1,442 patients without this arrhythmia. Each patient underwent comprehensive clinical, laboratory, and instrumental evaluations.
RESULTS
The emergence of PVCs in individuals afflicted with COVID-19 was associated with a 5.879-fold heightened risk of lethal outcome, a 2.904-fold elevated risk of acute myocardial infarction, and a 2.437-fold increased risk of pulmonary embolism. Upon application of diagnostic criteria to evaluate the "cytokine storm", it was discovered that the occurrence of the "cytokine storm" was notably more frequent in the group with PVCs, manifesting in six patients (3.5%), compared to 16 patients (1.1%) in the control group (P < 0.05). The mean extent of lung tissue damage in group I was significantly greater than that of patients in group II (P < 0.05). Notably, the average oxygen saturation level, as measured by pulse oximetry upon hospital admission was 92.63±3.84% in group I and 94.20±3.50% in group II (P < 0.05).
CONCLUSIONS
The presence of PVCs in COVID-19 patients was found to elevate the risk of cardiovascular complications. Significant independent predictors for the development of PVCs in patients with SARS-CoV-2 infection include: age over 60 years (risk ratio (RR): 4.6; confidence interval (CI): 3.2 - 6.5), a history of myocardial infarction (RR: 3.5; CI: 2.6 - 4.6), congestive heart failure (CHF) with reduced left ventricular ejection fraction (RR: 5.5; CI: 3.9 - 7.6), respiratory failure (RR: 2.3; CI: 1.7 - 3.1), and the presence of a "cytokine storm" (RR: 4.5; CI: 2.9 - 6.0).
PubMed: 38855779
DOI: 10.14740/jocmr5160 -
Frontiers in Veterinary Science 2024To evaluate the safety and feasibility of high flow oxygen therapy (HFOT), and to record SpO and desaturation episodes in dogs and cats receiving HFOT or conventional...
OBJECTIVES
To evaluate the safety and feasibility of high flow oxygen therapy (HFOT), and to record SpO and desaturation episodes in dogs and cats receiving HFOT or conventional oxygen therapy (COT) during bronchoscopy ± bronchoalveolar lavage (BAL).
MATERIALS AND METHODS
Dogs and cats undergoing bronchoscopy ± BAL between January and May 2023 were included in the study. Patients were randomly allocated to two groups: HFOT (HFOT group; two cats and four dogs) and COT (COT group; one cat and five dogs). HFOT and COT were started at the beginning of the bronchoscopy. HFOT was delivered with a gas flow rate of 1 L/kg/min at an FiO of 100% and a temperature of 34°C (pediatric mode) or 37°C (adult mode). COT was delivered through the working channel of the bronchoscope at a rate of 1.5 L/min. The safety and feasibility of HFOT were assessed, and peripheral oxygen saturation (SpO) was measured by pulse oximetry every 30 s throughout the procedure.
MEASUREMENTS AND MAIN RESULTS
HFOT was feasible and safe in both dogs and cats with no complications reported. While there was no significant difference in the number of desaturation episodes (SpO < 94%) between the two groups, none of the patients in the HFOT group experienced severe desaturation (SpO < 90%). In contrast, two patients in the COT group had an SpO < 90%. Mean SpO was significantly higher in the HFOT group compared to the COT group at T0 (98% ± 2% vs. 94 ± 2%), T0.5 (98% ± 2% vs. 94% ± 3%) and T1 (98% ± 2% vs. 94% ± 4%).
CONCLUSION
To the authors' knowledge, this is the largest study conducted to date using HFOT during bronchoscopy in dogs and cats. Our results suggest that HFOT is feasible and safe during bronchoscopy ± BAL. Furthermore, HFOT may reduce the risk of desaturation episodes in dogs and cats undergoing bronchoscopy and BAL.
PubMed: 38855409
DOI: 10.3389/fvets.2024.1360017 -
Future of neurocritical care: Integrating neurophysics, multimodal monitoring, and machine learning.World Journal of Critical Care Medicine Jun 2024Multimodal monitoring (MMM) in the intensive care unit (ICU) has become increasingly sophisticated with the integration of neurophysical principles. However, the... (Review)
Review
Multimodal monitoring (MMM) in the intensive care unit (ICU) has become increasingly sophisticated with the integration of neurophysical principles. However, the challenge remains to select and interpret the most appropriate combination of neuromonitoring modalities to optimize patient outcomes. This manuscript reviewed current neuromonitoring tools, focusing on intracranial pressure, cerebral electrical activity, metabolism, and invasive and noninvasive autoregulation monitoring. In addition, the integration of advanced machine learning and data science tools within the ICU were discussed. Invasive monitoring includes analysis of intracranial pressure waveforms, jugular venous oximetry, monitoring of brain tissue oxygenation, thermal diffusion flowmetry, electrocorticography, depth electroencephalography, and cerebral microdialysis. Noninvasive measures include transcranial Doppler, tympanic membrane displacement, near-infrared spectroscopy, optic nerve sheath diameter, positron emission tomography, and systemic hemodynamic monitoring including heart rate variability analysis. The neurophysical basis and clinical relevance of each method within the ICU setting were examined. Machine learning algorithms have shown promise by helping to analyze and interpret data in real time from continuous MMM tools, helping clinicians make more accurate and timely decisions. These algorithms can integrate diverse data streams to generate predictive models for patient outcomes and optimize treatment strategies. MMM, grounded in neurophysics, offers a more nuanced understanding of cerebral physiology and disease in the ICU. Although each modality has its strengths and limitations, its integrated use, especially in combination with machine learning algorithms, can offer invaluable information for individualized patient care.
PubMed: 38855276
DOI: 10.5492/wjccm.v13.i2.91397 -
Health Informatics Journal 2024This study develops machine learning-based algorithms that facilitate accurate prediction of cerebral oxygen saturation using waveform data in the near-infrared range...
This study develops machine learning-based algorithms that facilitate accurate prediction of cerebral oxygen saturation using waveform data in the near-infrared range from a multi-modal oxygen saturation sensor. Data were obtained from 150,000 observations of a popular cerebral oximeter, Masimo O3™ regional oximetry (Co., United States) and a multi-modal cerebral oximeter, Votem (Inc., Korea). Among these observations, 112,500 (75%) and 37,500 (25%) were used for training and test sets, respectively. The dependent variable was the cerebral oxygen saturation value from the Masimo O3™ (0-100%). The independent variables were the time of measurement (0-300,000 ms) and the 16-bit decimal amplitudes values (infrared and red) from Votem (0-65,535). For the right part of the forehead, the root mean square error of the random forest (0.06) was much smaller than those of linear regression (1.22) and the artificial neural network with one, two or three hidden layers (2.58). The result was similar for the left part of forehead, that is, random forest (0.05) vs logistic regression (1.22) and the artificial neural network with one, two or three hidden layers (2.97). Machine learning aids in accurately predicting of cerebral oxygen saturation, employing the data from a multi-modal cerebral oximeter.
Topics: Humans; Oximetry; Machine Learning; Oxygen Saturation; Algorithms; Female; Male; Oxygen
PubMed: 38847787
DOI: 10.1177/14604582241259341 -
Cardiovascular Diabetology Jun 2024Micro- and macrovascular diseases are common in patients with type 2 diabetes mellitus (T2D) and may be partly caused by nocturnal hypoxemia. The study aimed to...
BACKGROUND
Micro- and macrovascular diseases are common in patients with type 2 diabetes mellitus (T2D) and may be partly caused by nocturnal hypoxemia. The study aimed to characterize the composition of nocturnal hypoxemic burden and to assess its association with micro- and macrovascular disease in patients with T2D.
METHODS
This cross-sectional analysis includes overnight oximetry from 1247 patients with T2D enrolled in the DIACORE (DIAbetes COhoRtE) study. Night-time spent below a peripheral oxygen saturation of 90% (T90) as well as T90 associated with non-specific drifts in oxygen saturation (T90), T90 associated with acute oxygen desaturation (T90) and desaturation depths were assessed. Binary logistic regression analyses adjusted for known risk factors (age, sex, smoking status, waist-hip ratio, duration of T2D, HbA1c, pulse pressure, low-density lipoprotein, use of statins, and use of renin-angiotensin-aldosterone system inhibitors) were used to assess the associations of such parameters of hypoxemic burden with chronic kidney disease (CKD) as a manifestation of microvascular disease and a composite of cardiovascular diseases (CVD) reflecting macrovascular disease.
RESULTS
Patients with long T90 were significantly more often affected by CKD and CVD than patients with a lower hypoxemic burden (CKD 38% vs. 28%, p < 0.001; CVD 30% vs. 21%, p < 0.001). Continuous T90 and desaturation depth were associated with CKD (adjusted OR 1.01 per unit, 95% CI [1.00; 1.01], p = 0.008 and OR 1.30, 95% CI [1.06; 1.61], p = 0.013, respectively) independently of other known risk factors for CKD. For CVD there was a thresholdeffect, and only severly and very severly increased T90 was associated with CVD ([Q3;Q4] versus [Q1;Q2], adjusted OR 1.51, 95% CI [1.12; 2.05], p = 0.008) independently of other known risk factors for CVD.
CONCLUSION
While hypoxemic burden due to oxygen desaturations and the magnitude of desaturation depth were significantly associated with CKD, only severe hypoxemic burden due to non-specific drifts was associated with CVD. Specific types of hypoxemic burden may be related to micro- and macrovascular disease.
Topics: Humans; Diabetes Mellitus, Type 2; Male; Female; Middle Aged; Cross-Sectional Studies; Aged; Hypoxia; Risk Factors; Oximetry; Circadian Rhythm; Oxygen Saturation; Diabetic Angiopathies; Time Factors; Renal Insufficiency, Chronic
PubMed: 38844945
DOI: 10.1186/s12933-024-02289-w -
Journal of Biomedical Optics Jun 2024Photoacoustic imaging (PAI) promises to measure spatially resolved blood oxygen saturation but suffers from a lack of accurate and robust spectral unmixing methods to...
SIGNIFICANCE
Photoacoustic imaging (PAI) promises to measure spatially resolved blood oxygen saturation but suffers from a lack of accurate and robust spectral unmixing methods to deliver on this promise. Accurate blood oxygenation estimation could have important clinical applications from cancer detection to quantifying inflammation.
AIM
We address the inflexibility of existing data-driven methods for estimating blood oxygenation in PAI by introducing a recurrent neural network architecture.
APPROACH
We created 25 simulated training dataset variations to assess neural network performance. We used a long short-term memory network to implement a wavelength-flexible network architecture and proposed the Jensen-Shannon divergence to predict the most suitable training dataset.
RESULTS
The network architecture can flexibly handle the input wavelengths and outperforms linear unmixing and the previously proposed learned spectral decoloring method. Small changes in the training data significantly affect the accuracy of our method, but we find that the Jensen-Shannon divergence correlates with the estimation error and is thus suitable for predicting the most appropriate training datasets for any given application.
CONCLUSIONS
A flexible data-driven network architecture combined with the Jensen-Shannon divergence to predict the best training data set provides a promising direction that might enable robust data-driven photoacoustic oximetry for clinical use cases.
Topics: Photoacoustic Techniques; Oximetry; Humans; Neural Networks, Computer; Oxygen; Oxygen Saturation; Algorithms
PubMed: 38841431
DOI: 10.1117/1.JBO.29.S3.S33303 -
Injury May 2024The aim of this study was to investigate the association between patient age and guideline adherence for prehospital care in emergency medical services (EMS) for...
OBJECTIVES
The aim of this study was to investigate the association between patient age and guideline adherence for prehospital care in emergency medical services (EMS) for moderate to severe trauma.
METHODS
This was a retrospective observational study that used a nationwide EMS-based trauma database from 2016 to 2019. Adult trauma patients whose injury severity score was greater than or equal to nine were screened, and those with cardiac arrest or without outcome data were excluded. The enrolled patients were categorized into four groups according to patient age: young (<45 years), middle-aged (45-64 years), old (65-84 years), and very old (>84 years). The primary outcome was guideline adherence, which was defined as following all prehospital care components: airway management for level of consciousness below verbal response, oxygen supply for pulse oximetry under 94 %, intravenous fluid administration for systolic blood pressure under 90 mmHg, scene resuscitation time within 10 min, and transport to the trauma center or level 1 emergency department. Multivariable logistic regression was conducted to calculate the adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs).
RESULTS
Among the 430,365 EMS-treated trauma patients, 38,580 patients were analyzed-9,573 (24.8 %) in the young group, 15,296 (39.7 %) in the middle-aged group, 9,562 (24.8 %) in the old group, and 4,149 (10.8 %) in the very old group. The main analysis revealed a lower probability of guideline adherence in the old group (aOR 95 % CI = 0.84 (0.76-0.94)) and very old group (aOR 95 % CI = 0.68 (0.58-0.81)) than in the young group.
CONCLUSION
We found disparities in guideline adherence for prehospital care according to patient age at the time of EMS assessment of moderate to severe trauma. Considering this disparity, the prehospital trauma triage and management for older patients needs to be improved and educated to EMS providers.
PubMed: 38839516
DOI: 10.1016/j.injury.2024.111630